Equis ISSN 2398-2977

Behavior: headshaking

Contributor(s): Bonnie Beaver, Sarah Binns, Caroline Hahn, Prof Derek Knottenbelt, Daniel Mills, Veronica Roberts


  • Headshaking describes the presenting sign of a multitude of conditions.
  • It is a challenge to identify the cause of this clinical sign and to then treat it.
  • Cause: many; likely that the majority suffer a facial pain syndrome.
  • Signs: headshaking, snorting, nose rubbing, striking at the nose.
  • Diagnosis: history and clinical examination, oral and ophthalmic examination, endoscopy of upper respiratory tract and guttural pouches, CT, diagnostic local analgesia.
  • Treatment: if a facial pain syndrome due to a likely trigeminal neuropathy: use of a nose net, carbemazepine and/or cyproheptadine, caudal compression surgery.
  • Prognosis: depends on cause.
Print off the Owner factsheet on Headshaking to give to your clients.



  • There are many reasons why a horse may shake its head, for example poor dentition, bad riding, ear mites. 
  • In the majority of horses no significant abnormalities can be detected, even following extensive investigations. 
  • It is likely that the majority of these horses are headshaking due to facial pain which may be due to a trigeminal neuropathy.
  • The pathology behind the condition is unknown.
  • There are clinical similarities to human facial pain syndromes, most notably trigeminal neuralgia.


  • Typically progresses to increasing severity over years. 
  • May remain stable, fluctuate or resolve.


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Further Reading


Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Talbot W A, Pinchbeck G L, Knottenbelt D C, Graham H & McKane S A (2013) A randomised, blinded, crossover study to assess the efficacy of a feed supplement in alleviating the clinical signs of headshaking in 32 horses. Equine Vet J 45 (3), 293-297 PubMed.
  • Roberts V L, Perkins J D et al (2013) Caudal anaesthesia of the infraorbital nerve for diagnosis of idiopathic headshaking and caudal compression of the infraorbital nerve for its treatment, in 58 horses. Equine Vet J 45 (1), 107-110 PubMed.
  • Pickles K J et al (2011) Preliminary investigation of somatosensory evoked potentials in equine headshaking. Vet Rec 168 (19), 511 PubMed.
  • Roberts V (2011) Idiopathic headshaking in horses: understanding the pathophysiology. Vet Rec 168 (1), 17-18 PubMed.
  • Pickles K J et al (2011) Use of gonadotrophin-releasing hormone vaccine in headshaking horses. Vet Rec 168 (1), 19 PubMed.
  • Roberts V L H, McKane S A, Williams A & Knottenbelt D C (2009) Caudal compression of the infraorbital nerve: A novel surgical technique for treatment of idiopathic headshaking and assessment of its efficacy in 24 horses. Equine Vet J 41 (2), 165-170 PubMed.
  • Stalin C E, Boydell I P & Pike R E (2008) Treatment of seasonal headshaking in three horses with sodium cromoglycate eye drops. Vet Rec 163 (10), 305-306 PubMed.
  • Stephenson R (2005) An unusual case of headshaking caused by a premaxillary bone cyst. Equine Vet Educ 17 (2), 79-82 VetMedResource.
  • Newton S (2005) Idiopathic headshaking in horses. Equine Vet Educ 17 (2), 83-91 VetMedResource.
  • Mills D S, Cook, S, Taylor K & Jones B (2002) Analysis of the variations in clinical signs shown by 254 cases of equine headshaking. Vet Rec 150, 236-240 PubMed.
  • Mills D S, Cook S & Jones B (2002) Reported response to treatment among 245 cases of equine headshaking. Vet Rec 150, 311-313 PubMed.
  • Taylor K D, Cook S & Mills D S (2001) A case-controlled study investigating health, management and behavioral features of horses commonly described as headshakers. Ippologia 12, 29-37 VetMedResource.
  • Newton S A, Knottenbelt D C & Eldridge P R (2000) Headshaking in horses - possible aetiopathogenesis suggested by the results of diagnostic tests and several treatment regimes used in 20 cases. Equine Vet J 32, 208-216 VetMedResource.
  • Mair T S (1999) Assessment of bilateral infra-orbital nerve blockade and bilateral infra-orbital neurectomy in the investigation and treatment of idiopathic headshaking. Equine Vet Educ 31 (3), 262-264 PubMed.
  • Wilkins P A (1997) Cyproheptadine - Medical treatment for photic headshakers. Comp Contin Educ Pract Vet 19 (1), 98 VetMedResource.
  • Moore L A, Johnson P J, Messer N T et al (1997) Management of headshaking in horses by treatment for protozoal myeloencephalitis. Vet Rec 141 (11), 264-267 PubMed.
  • Madigan J E, Kortz G, Murfy C & Rodger L (1995) Photic headshaking in the horse - 7 cases. Equine Vet J 27 (4), 306-311 PubMed.
  • Mair T S (1994) Headshaking associated with Trombicula autumnalis larval infestation in 2 horses. Equine Vet J 26 (3), 244-245 PubMed.
  • Cook W R (1992) Headshaking in horses, an afterword. Comp Contin Educ 14 (10), 1369-1371 VetMedResource.
  • Cook W R (1979/1980) Headshaking in horses - Parts 1-4. Equine Pract 1, 9-17 & 36-39; 2, 31-40 VetMedResource Part I Part II Part III Part IV.
  • Dodman N H, Shuster L, Court M H & Dixon R (1987) Investigation into the use of narcotic antagonists in the treatment of a stereotypic behavior pattern (crib-biting) in the horse. Am J Vet Res 48 (2), 311-319 PubMed.
  • Lane J G & Mair T S (1987) Observations on headshaking in the horse. Equine Vet J 19 (4), 331-336 PubMed.